Provider First Line Business Practice Location Address:
2500 W 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66049-2447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-500-6436
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2026